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ABSTRACT: Occupational exposure to skin irritants, in particular to water, is an important risk factor for hand eczema.
To assess occupational skin exposure to water in the general population.
As part of a public health survey in Stockholm, Sweden, 18,267 gainfully employed individuals aged 18-64 years completed a questionnaire with previously validated questions regarding occupational skin exposure to water.
Altogether 16% reported exposure to water for (1/2) h or more a day, and 13% reported exposure to water more than 10 times a day. Furthermore, 7% reported water exposure of more than 2 h and 6% of more than 20 times a day. Women reported more water exposure than men and many female-dominated occupations were seen to comprise water exposure. Women were also more exposed than men within the same jobs. Young adults were more exposed than older. A total of 18% were employed in high-risk occupations for hand eczema. Fifty-nine per cent of individuals employed in high-risk occupations reported water exposure at work, compared with 11% in low-risk occupations.
A total of 20% of the population of working age acknowledged occupational skin exposure to water, which was found to be more common in young adults and women. Using job title as a proxy for water exposure gives an underestimation due to misclassification. In assessing occupational skin exposure to water, both exposure time and frequency should be considered.
British Journal of Dermatology 10/2008; 160(3):616-21. · 3.67 Impact Factor
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ABSTRACT: Exposure to wood dust within the woodworking industry has been shown to cause a variety of respiratory disorders. The aim of this study was to investigate the cellular effects in bronchoalveolar lavage (BAL) fluid and peripheral blood from healthy individuals exposed to pinewood dust. Eleven healthy volunteers were exposed to pinewood dust for 1 h in a whole-body exposure chamber. BAL fluid and blood cells were differentially counted and the expression of activation, adhesion and subset markers on alveolar macrophages and T-lymphocytes was determined 2-6 weeks before and 20 h after the exposure. Following pinewood dust exposure, the total BAL fluid cell concentration increased from 81.4 (64.1-97.5) x 10(6) cells x L(-1) (median (interquartile range)) to 195.3 (154.6-341.2) x 10(6) cells x L(-1). The BAL fluid T-lymphocyte concentration increased from 3.8% (3.5-6.5%) to 7.6% (4.9-11.2%), and BAL fluid eosinophil concentration from 0.0% (0.0-0.2%) to 1.8% (0.6-3.5%). Inhalation of pinewood dust leads to the recruitment of inflammatory cells to the airways of healthy individuals. The increase in numbers of eosinophils, T-lymphocytes and mast cells, i.e. cells of crucial importance to airway inflammation, in the lungs may be related to the increased risk of developing respiratory disorders among woodworkers.
European Respiratory Journal 02/2005; 25(1):118-24. · 5.89 Impact Factor
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ABSTRACT: Starch is a main component of wheat flour, which, besides being an occupational allergen can also induce irritative symptoms in the airways. A purified starch product (cornstarch glove powder) was used to investigate whether starch alone could induce airway inflammation. The aim of the study was to investigate a role for starch in wheat flour-induced airway inflammation. Ten healthy individuals were exposed to cornstarch glove powder in a whole-body exposure chamber. Bronchoscopy with bronchoalveolar lavage (BAL) was performed 2-3 weeks before and 1 day after exposure, and the BAL cells were counted differentially. In addition, the expression of activation, adhesion and subset markers on alveolar macrophages and BAL T-cells were investigated using flow cytometry. A three-fold increase in BAL cell concentrations was found, with a selective accumulation and activation of eosinophilic granulocytes, as well as an influx of nonactivated monocytes and polyclonal CD4+ T-cells into the airways. The results show that inhalation of cornstarch glove powder leads to the development of a subclinical inflammation in the airways, with an accumulation of eosinophilic granulocytes. The authors suggest that such exposure may be an interesting model for studying factors contributing to lung accumulations of eosinophil granulocytes in humans.
European Respiratory Journal 05/2003; 21(4):646-51. · 5.89 Impact Factor
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ABSTRACT: There is a lack of information concerning whether environmental-related health effects are more or less prevalent or manifested differently in women compared to men. Previously, most research in the area of toxicology and environmental and occupational health involved male subjects. The present work aims at reviewing exposure and health effects of cadmium, nickel, lead, mercury, and arsenic manifested differently in women than in men. The gender difference in exposure to nickel results in a much higher prevalence of nickel allergy and hand eczema in women than in men. The internal cadmium dose is generally higher in women than in men, due to a higher gastro-intestinal absorption at low iron stores. This was probably one major reason why Itai-itai disease was mainly a woman's disease. Yet, data are sparse regarding the risk for women relative to men to develop cadmium-induced kidney damage in populations exposed to low levels of cadmium. Lead is accumulated mainly in bone and increased endogenous lead exposure has been demonstrated in women during periods of increased bone turnover, e.g., menopause. Both lead and mercury exposure in pregnant women has to be kept low in order to prevent neurodevelopment effects in the developing fetus and child. Limited data indicate that women are more affected than men following exposure to methylmercury at adult age, while males seem to be more sensitive to exposure during early development. Regarding arsenic, some data indicate gender differences in the biotransformation by methylation, possibly also in susceptibility to certain arsenic-related cancers. Obviously, gender-related differences in exposure and health effects caused by metals are highly neglected research areas, which need considerable focus in the future.
Environmental Research 04/2002; 88(3):145-55. · 3.40 Impact Factor
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ABSTRACT: In a population-based survey of public health issues in Stockholm, Sweden, self-reported hand eczema, history of childhood eczema, nickel allergy, occurrence of skin symptoms on the face and intolerance to cosmetics and hygiene products, were investigated. A postal questionnaire was sent to 15,000 inhabitants aged 19-80 years. The response rate was 73%. The 1-year prevalence of hand eczema was 8% (females 10%, males 6%). History of childhood eczema was reported by 15% and, of these, 42% also stated positively that they had had hand eczema at some time. Hypersensitivity to nickel was owned to 15% of the females and 3% of the males. Of the nickel-sensitive, 30% reported ever having had hand eczema. The combination of nickel allergy and history of childhood eczema resulted in a cumulative prevalence of hand eczema of 56%. Females reported more hand-washings per day than did males, and a relation between number of hand-washings and hand eczema was found. Self-reported 1-year prevalence of skin symptoms on the face was 14% and, of these, 33% also owned to hypersensitivity to cosmetics. Dermatitis appears to be a common health problem. This fact should be made clear to those who give priority and allocate resources to health problems, e.g., by participation of dermatologists in performing population-based surveys.
Contact Dermatitis 01/2002; 45(6):341-5. · 3.51 Impact Factor
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ABSTRACT: Nickel allergy is the most frequent contact allergy and is also one of the major background factors for hand eczema. The clinical significance of nickel release from coins was discussed when the composition of euro coins was decided. Current European coinage is dominated by cupro-nickel coins (Cu 75; Ni 25); other nickel-containing and non-nickel alloys are also used. Nickel release from used coinage from the UK, Sweden and France was determined. It was shown that nickel ions are readily available on the surface of used coins. After 2 min in artificial sweat, approximately 2 microg of nickel per coin was extracted from cupro-nickel coins. Less nickel was extracted from non-nickel coins. Nickel on the surface was mainly present as chloride. After 1 week in artificial sweat approximately 30 microg/cm2 was released from cupro-nickel coins: less nickel was released from coins made of other nickel alloys. Theoretically, several microg of nickel salts may be transferred daily onto hands by intense handling of high-nickel-releasing coins.
Contact Dermatitis 04/2001; 44(3):160-5. · 3.51 Impact Factor
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C Lidén
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ABSTRACT: Legislation can be a useful tool in the prevention of contact dermatitis. This is particularly true for dermatitis due to exposure to the many contact allergens that are chemical substances in products. A brief review is given of the most important European legislation--the EU Nickel Directive, the Cosmetics Directive, the Hazardous Substances Directive and the Hazardous Preparations Directive--and of some national regulations and standardization projects. It is concluded that it is essential that experts on contact dermatitis support, with their expert knowledge, national and European authorities.
Contact Dermatitis 03/2001; 44(2):65-9. · 3.51 Impact Factor
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ABSTRACT: Nickel allergy is by far the most frequent contact allergy, affecting 10-15% of women in the general population, and causing dermatitis and hand eczema. The EU Nickel Directive, aimed at the prevention of nickel allergy, comes fully into force by July 2001. The Directive covers piercing materials, items in contact with the skin, and requirements on resistance to wear. We carried out a study of the prevalence on the market, before the Nickel Directive, of items that release nickel and of nickel in piercing posts. Nickel release, as shown by a positive dimethylglyoxime (DMG) test, was detected in 25% of 725 items intended for direct and prolonged contact with the skin. Of 15 posts intended for use during epithelialization after piercing, 60% contained more than 0.05% nickel. These products do not comply with the requirements of the EU Nickel Directive. It is suggested that experts in contact dermatitis participate in the prevention of nickel allergy by explaining its effects: the r le of skin exposure and which parts of an item are in contact with the skin, and the crucial question of nickel release versus nickel content.
Contact Dermatitis 02/2001; 44(1):7-12. · 3.51 Impact Factor
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ABSTRACT: The fungicide chlorothalonil is used extensively under several tradenames for the protection of various horticultural and fruit crops and bananas against fungal infections. It is also used as fungicide in wood preservation and as a preservative in paints. Clinical experience has shown chlorothalonil to be a contact allergen and several cases of allergic contact dermatitis attributed to chlorothalonil have been described. 2 previous guinea pig maximization test studies have shown the sensitizing potential of chlorothalonil to be high. The sensitizing property of chlorothalonil was studied by us with the predictive test methods the local lymph node assay and the cumulative contact enhancement test. In the local lymph node assay, chlorothalonil induced a dose-dependent increase in proliferation with a maximal stimulation index of 19.2 and 27.2. In the cumulative contact enhancement test, a statistically significant dose-dependent high sensitization rate was seen with a maximal sensitization rate of 100%. In conclusion, it is evident that chlorothalonil is an extremely potent contact allergen, inducing sensitization using only topical exposure on intact skin.
Contact Dermatitis 12/2000; 43(5):273-9. · 3.51 Impact Factor
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Lakartidningen 06/2000; 97(20):2516, 2519.
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ABSTRACT: The relevance of patch-test reactivity to chemicals on cross-challenge is hard to state, but it is generally assumed that the patient might risk a relapse of contact dermatitis when exposed to the cross-reacting compound(s).
To study relevance by using the repeated open application test (ROAT) and applying the inducing allergen cobalt chloride (CoCl(2)) or nickel sulfate (NiSO(4)) as well as the possibly cross-reacting compound (NiSO(4) or CoCl(2)) topically to guinea pigs. Method:Animals were induced according to the guinea pig maximization test (GPMT) method, patch tested and then treated for 10 days using ROATs. Sensitivity thresholds were determined with serial dilution tests.
Guinea pigs induced with CoCl(2) reacted in patch testing (100%) and in ROATs to CoCl(2) (93%) but not to NiSO(4). Animals induced with NiSO(4) reacted in patch testing to NiSO(4) (100%) but not to CoCl(2), and in the ROATs to NiSO(4) (41%) and less to CoCl(2).
Our results support the assumption that the concomitant patch test reactivity is due to multiple sensitizations rather than cross-reactivity. We previously found that animals induced with palladium chloride (PdCl(2)) also reacted to NiSO(4) on patch testing but not in the ROATs, indicating that the results from patch testing might overestimate the risk of a relapse. ROATs in patients with solitary and/or concomitant sensitivity to CoCl(2), NiSO(4) or PdCl(2) are desirable.
American Journal of Contact Dermatitis 04/2000; 11(1):42-8.
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ABSTRACT: A multi-dose-response induction protocol for the guinea pig maximization test (GPMT), including a statistical computer program, has earlier been developed to improve the power of predictive tests for identification of contact allergens. This dose-response protocol, with 2 modifications (i.e., increased number of animals in each group and increased number of challenge concentrations) was evaluated in the GPMT, the cumulative contact enhancement test (CCET) and the Freund's complete adjuvant test (FCAT), using potassium dichromate and hydroxycitronellal as model contact allergens. Application of the dose-response protocol on the CCET and the FCAT resulted in either monotone or non-monotone curves with significant dose-response. However, application of the dose-response protocol on the GPMT gave curves with no significant dose-response. The protocol makes it possible to obtain an EC50 value, thus improving the possibility of ranking contact allergens, which is of substantial use for risk assessments. The dose-response protocol could benefit from a few adjustments: a wider span in the induction doses; change to simultaneous increase in intradermal and topical induction doses to obtain a proper dose-response for the GPMT; the addition of further challenge concentrations. In addition the computer program should allow calculation of threshold concentration for sensitization and EC50 value for a non-monotone curve.
Contact Dermatitis 11/1999; 41(4):198-206. · 3.51 Impact Factor
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ABSTRACT: Cross-reactivity is usually studied with patch test techniques, but the relevance of a single 1-2 day exposure under occlusion can be questioned. To study relevance, animals were induced with PdCl2 or NiSO4 according to the guinea pig maximization test method and then treated for 10 days according to the repeated open application test (ROAT) method. Animals induced with PdCl2 reacted in the ROATs to PdCl2 (100%) but rarely to NiSO4. Animals induced with NiSO4 reacted in ROATs to the same degree with NiSO4 and PdCl2 (23-30%). The concordance between pre-ROAT patch test results and ROAT outcome was high for PdCl2 (100%) and low (10-40%) for NiSO4. Patch testing seems to overestimate the risk of skin reactions when guinea pigs sensitive to PdCl2 are treated topically with NiSO4. The finding from patch test studies that animals induced with NiSO4 react only to NiSO4 but not to PdCl2 was not confirmed. Repeated open applications more adequately mimic exposure conditions than does patch testing.
Contact Dermatitis 10/1999; 41(3):145-9. · 3.51 Impact Factor
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ABSTRACT: Metal release from 13 different gold-containing jewelry alloys stored for 1 and 3 weeks in artificial sweat was analysed. For chemical analysis, inductively-coupled plasma detection (ICP) and atomic absorption spectrophotometry (AA), with flame and with furnace, were used. No release of gold was detected. It is unlikely that skin contact with gold-containing metallic items such as jewelry is responsible for inducing contact allergy to gold or allergic contact dermatitis due to the gold. The patch-test reactivity to gold sodium thiosulfate needs to be explained by some other mechanism(s).
Contact Dermatitis 01/1999; 39(6):281-5. · 3.51 Impact Factor
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ABSTRACT: A new whole-body exposure chamber for human skin and lung challenge offers possibilities for experimental exposure challenges carried out in clinical practice, for exposure of patients, in research and for investigations of the effects of exposure on the skin and in the respiratory tract. The chamber system can be used for both aerosols and gases. Dynamically controlled, the chamber is relatively easy to operate and to clean. Air exchange rates can be varied between 6-12/h. Initial studies with wheat flour have been carried out. The homogeneity and stability of the wheat flour aerosol concentration (the spatial and the temporal variation) inside the chamber can be kept at acceptable levels.
Annals of Occupational Hygiene 12/1998; 42(8):541-7. · 1.95 Impact Factor
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ABSTRACT: Nickel allergy in women has been thoroughly studied: its prevalence, the most important sources of sensitization, and risk factors for elicitation of dermatitis. Preventive measures have also been introduced. Nickel allergy in men has not, however, been equally focused on. Based on clinical experience, some publications indicating that tools may be a risk factor for nickel allergy and hand eczema in men, and the fact that large occupational groups regularly use tools, we decided to carry out a study, of the prevalence on the market of tools that release nickel. 27% of 565 hand-held tools with metal parts that come into contact with the skin were found to be dimethylglyoxime (DMG) test positive. Release of nickel and other metals into artificial sweat and composition of metals on the surface and in the base alloy were also studied. It is suggested that tool producers should consider nickel allergy and avoid nickel-releasing materials, and that analytical methods, relevant for nickel release from tools, should be further developed.
Contact Dermatitis 10/1998; 39(3):127-31. · 3.51 Impact Factor
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ABSTRACT: The repeated open application test is used to assess the clinical relevance of positive patch test reactions to ingredients of formulated products. The great variation in outcome is usually claimed to be related to the concentration of the allergen responsible. We have here studied the quantitative aspects, specificity and effect of patch testing on the outcome of the repeated open application test in an animal model, using guinea pigs sensitized with cobalt chloride or colophony. Thresholds of sensitivity were determined before and after the topical treatments. Clear dose-response relationships were established. The reactivity in sham-treated controls and to the vehicles was minimal. The concordance between patch test results and outcome of the use tests was concentration-dependent and at low concentrations < 50%. The repeated open application test is a useful method, but some of the basic issues need further evaluation. This animal model will hopefully serve this purpose.
Acta Dermato Venereologica 12/1997; 77(6):420-4. · 3.18 Impact Factor
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ABSTRACT: A broad range of nickel-containing alloys and coatings used in jewellery, watches and clothes, were patch tested in 100 nickel-sensitive subjects and in 20 nickel-negative controls. Three non-plated stainless-steel alloys tested caused no patch-test reaction. Nickel interliners under gold, silver or chromium plating, as well as nickel-silver and some white-gold alloys, caused positive patch-test reactions. Ear ornaments, wristwatches and buttons were the objects most frequently causing dermatitis. Half the nickel-sensitive participants suspected that they had been sensitized before the age of 20. The results of the study have been used as the basis for developing clinically relevant analytical methods for nickel release. The methods are proposed as European Standards and will be used in the Nickel Directive, an EC regulation aiming at the prevention of nickel allergy.
British Journal of Dermatology 03/1996; 134(2):193-8. · 3.67 Impact Factor
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ABSTRACT: A connection between patch test reactions to paper extracts and contact allergy to rosin (colophony) has been demonstrated.
We wanted to determine whether a difference in the allergenic activity of various types of paper is related to a difference in the pulp.
Patients with dermatitis who were frequently exposed to paper were patch tested with extracts from various papers and the standard series. The extracts were also tested in volunteers with or without contact allergy to rosin and in animals. The rosin compounds in the papers were analyzed by gas chromatography.
The subjects reacting to paper extracts also reacted to rosin. Most reactions were found to the papers produced from mechanical pulps, which contained the highest analyzed amounts of rosin compounds. Animals sensitized to rosin reacted only to paper from mechanical pulp.
Papers based on mechanical pulps that are considered to be environmentally friendly have a greater potential to elicit positive patch test reactions than papers made from other pulps. The increased use of mechanical pulps in different applications may increase the incidence of rosin-related hand eczema.
Journal of the American Academy of Dermatology 10/1995; 33(3):427-32. · 3.99 Impact Factor
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ABSTRACT: The frequencies of cosmetics intolerance and contact allergy to colophony were investigated among 116 singers and dancers and 16 make-up artists. Participants were interviewed, examined and patch tested with a standard series and materials from the opera house. Common skin lesions were found in 1/3 of participants and more than 50% had a history of intolerance to cosmetics. Colophony gave positive patch test reactions in only 3 subjects. The prevalence of positive patch test reactions to fragrance mix and balsam of Peru was about the same as among dermatitis patients generally. Contact allergy to colophony did not seem to be a problem regarding cosmetics.
Contact Dermatitis 06/1995; 32(5):273-80. · 3.51 Impact Factor
